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OELWEIN FAMILY PHARMACY
DSH160067 MercyOne Waterloo Medical Center
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Covered Entity Details
Entity Name
MercyOne Waterloo Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160067
Entity Address
3421 W 9TH STREET
WATERLOO, IA 50702
Medicare Provider Number
160067
Participating Start Date
1/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
OELWEIN FAMILY PHARMACY
Pharmacy Address
DON'S PHARMACY, LTD
32 SOUTH FREDERICK
OELWEIN, IA 50662
Pharmacy Comments
Contract Details
Approval Date
8/1/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Timothy Huber, Vice President of Finance
(319) 272-7607
Contract Pharmacy Representative
Oelwein Family Pharmacy
Erica Bushaw, President
(319) 283-5254
Signed By Date
8/1/2017
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